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Source of the Statistics

Injury data were obtained from the database of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). CHIRPP is an injury surveillance system operating in the emergency departments of 10 pediatric and 4 general hospitals in Canada. Data collection began in April 1990 at the pediatric hospitals and between 1991 and 1995 in the general hospitals. CHIRPP is a program of the Injury and Child Maltreatment Section of the Health Surveillance and Epidemiology Division, Public Health Agency of Canada.

Briefs and reports are updated when there is reason to believe the injuries or circumstances surrounding the injuries have changed. For example, the report of injuries associated with a specific product would be updated if the manufacturing regulations for the product are changed to include a new safety element. There is no need to update reports on a regular basis because the data collection sites are not a representative sample of all Canadian hospitals. Frequent updates would simply increase the number of records included in the report but not necessarily result in any change in the patterns and distributions found.

Limitations

It is important to note that the injuries described do not represent all injuries in Canada, but only those seen at the emergency departments of the 14 hospitals in the CHIRPP network. Since most of the data comes from the pediatric hospitals, which are in major cities, injuries suffered by the following people are under-represented in the CHIRPP database: older teenagers and adults, who are seen at general hospitals; native people; and people who live in rural areas. Fatal injuries are also under-represented in the CHIRPP database because the emergency department data do not capture people who died before they could be taken to hospital or those who died after being admitted.

Inclusion and Exclusion Criteria

A May 2008 search of the CHIRPP database for injuries associated with bicycles was conducted (ages 1 year and older; 1,850,948 records total). The records were retained if i) the narrative contained one of the following text strings: “BIKE”, “BICYCLE”, “TRICYCLE”, “UNICYCLE”, “CYCLE” , “BICYCLETTE”, “VELO” or “PEDALER ii) and the injury occurred in 2006. This final dataset was then reviewed manually to confirm all cases occurred outdoors, were associated with non-motorized bicycles. Cases involving exercise bikes, motocross, motorcycle, motorized dirt bikes, or toy bikes were excluded.

Recommended Citation

Injury briefs and reports and data from them may be copied and circulated freely provided that the source is acknowledged. The following citation is recommended:

For more information

Please contact the Injury and Child Maltreatment Section, Health Surveillance and Epidemiology Division, by PHONE at (613) 957-4689, by FAX at

(613) 941-9927 or visit our website.

Overall Pattern

Overall, 3,993 cases were identified where the injury was associated with a bicycle (3526.1 cases per 100 000 CHIRPP records). Among 2006 CHIRPP cases, this represents 3.4% of total cases, approximately 9% of all sports and recreation activities, and 44% of all wheeled, non-motorized activities (bikes, scooters, scooter boards, inline skates and skateboards).

There were 11% of cases admitted to hospital for treatment, compared to a 7.0% admittance rate for CHIRPP during the same timeframe for all injuries. The leading injuries reported were fractures (34.0%), lacerations (18.0%), and minor head injuries or concussions (7.3%). The majority of injuries occurred between April and October (94%), with a slightly higher proportion on the weekend (16%) than the weekdays (14%).

The analysis will be divided into cases involving children (between 1 and 10 years of age) (43.1% of cases), youth (11-15 years) (40.3% of cases) and adults (16 years and up) (16.7% of cases), to compare patterns among these groups. For all age groups combined, the median age was 11.9 and the interquartile range was 6.3 years (minimum age 1 year, maximum age 85 years). Analysis of the adult age group indicates a median age of 24 years.

1Because CHIRRP collects information from ten children’s hospitals and only five of the general hospitals, there is a high number of young children in the database. Using cases per 100,000 within an age group (instead of percentage by age group) adjusts for this uneven distribution. 2The proportion of males in the entire CHIRPP database for the given age group.

Circumstances

Table 2 describes the circumstances at the time of injury. Overall, the circumstances which led to the injury can be classified broadly into either Loss of Control (81.0%) or Collision (14.6%). The percentage of injuries associated with loss of control decrease significantly between children (82.7%) and adults (78.7%) ( X2(1, N=2386) = 5.09, p<.05). The percentage of injuries involving collisions do not differ between children (13.4%) and adults (16.4%) when tested (X2 (1, N=2386) = 3.53, p>.05).

**Unintended includes cases such as where more than one patient on bike, riding in inappropriate place.

Injuries

There are up to 3 injuries recorded for each patient. For this analysis, there were a total of 5,075 injuries associated with 3,993 patients. Table 3 lists the nature of injury by body part for only the first, most serious injury. Overall, fractures were the most frequently occurring injury (34.0%) (upper extremity comprised 80% of all fractures), followed by lacerations (17.5%) and soft tissue injuries (15.3%). This pattern is consistent across all 3 age groups.

Table 3. Nature of injury, associated with bicycles, CHIRPP, by age group, 2006.

Body part Nature of injury

Total

Children

Youth

Adult

# cases (%)

# cases (%)

# cases (%)

# cases (%)

Upper extremities

1797 (45.0)

714 (41.5)

790 (49.2)

293 (44.0)

fracture

1077

459

485

135

soft tissue

286

109

132

45

abrasion

203

65

78

60

sprain/strain

96

32

46

18

laceration

91

39

33

19

amputation -finger

3

2

1

0

other

41

8

15

16

Lower extremities

838 (21.0)

308 (17.9)

376 (23.4)

154 (23.1)

laceration

236

93

117

26

fracture

191

60

91

40

soft tissue

181

71

79

31

abrasion

130

51

48

31

sprain/strain

72

24

32

16

other

27

9

9

10

Face (including eye and mouth)

528 (13.2)

328 (19.1)

122 (7.6)

78 (11.7)

laceration

298

198

60

40

abrasion

79

52

20

7

dental

68

45

20

3

fracture

41

11

12

18

soft tissue/bruise

24

12

5

7

other

18

10

5

3

Head

399 (10.0)

192 (11.2)

165 (10.3)

42 (6.3)

minor closed head injury

176

94

67

15

concussion

115

49

57

9

scalp laceration

38

22

11

5

intracranial

30

7

17

6

abrasion

18

8

4

6

skull fracture

14

5

8

1

other

8

7

1

0

Trunk

298 (7.5)

128 (7.4)

110 (6.9)

60 (9.0)

soft tissue

101

55

31

15

abrasion

90

40

28

22

internal injuries

43

13

26

4

laceration

36

18

16

2

fracture

20

0

6

15

other

8

2

3

2

Neck and spine

41 (0.1)

14 (0.8)

16 (1.0)

11 (1.7)

soft tissue

15

6

5

4

fracture

10

1

6

3

sprain/strain

8

5

2

1

other

8

2

3

3

Other or unknown

92 (2.3)

36 (2.1)

28 (1.7)

28 (4.2)

Total

3,993 (100.0)

1,720 (100.0)

1,607 (100.0)

666 (100.0)

Treatment in Emergency Department

Table 4 reports what treatment the patient received in the emergency department (ED). Children were admitted at a rate of 8.7%, increasing to 11.6% in youth (X2(1, N=3,327) =8.09, p<.01) and further increasing to 15.3% in the adult age group (X2 (1, N=2,273) =5.74, p<.05). The 2 fatalities followed impact by a motor vehicle.

Table 4. Treatment received in emergency departments, injuries associated with bicycles, CHIRPP, by age groups, 2006.

Treatment in Emergency Department

Total

Children

Youth

Adult

# cases (%)

# cases (%)

# cases (%)

# cases (%)

Left without being seen

55 (1.4)

25 (1.5)

16 (1.0)

14 (2.1)

Advice

364 (9.1)

214 (12.4)

136 (8.5)

14 (2.1)

Treated, medical follow-up if necessary

1,426 (35.7)

585 (34.0)

505 (31.4)

336 (50.4)

Treated, medical follow-up required

1,576 (39.5)

693 (40.3)

695 (43.3)

188 (28.2)

Short stay, observed in ED

131 (3.3)

53 (3.1)

66 (4.1)

12 (1.8)

Admitted to hospital

438 (11.0)

149 (8.7)

187 (11.6)

102 (15.3)

Fatal

2 (0.05)

1 (0.06)

1 (0.06)

0 (0.0)

Total

3,993 (100.0)

1,720 (100.0)

1,607 (100.0)

666 (100.0)

Helmet Use

There were 2,993 cases where helmet status was reported (75%); and among these cases, nearly 63% reported wearing a helmet. Analysis by helmet use demonstrated riders who were not wearing a helmet experienced an admittance rate of 12%, compared to 7% of riders who did. Table 5 illustrates helmet use, where status was reported, decreased as age increased.

Handle Bar Impact

Cases associated with handlebar impact were identified as they are typically serious, often resulting in internal injuries. 3,4 There were 193 cases (4.8%) were the rider made contact with the handlebars and 15% of these were admitted to hospital, compared with an overall admittance rate of 11%. Of admitted cases, 73% were for treatment of internal injuries; of these 78% were associated with loss of control and 15% with a collision.